Keeping Our Eyes on the Health Reform Prize

by Lloyd H. Dean, President/CEO, Catholic Healthcare West and David Lansky, Ph.D., President, Pacific Business Group on Health

On the anniversary of health reform, let's remember that we just started making the deep changes that will transform our fragmented health care system into a modern, coordinated approach to care that will reduce cost and improve quality. Health care costs too much. That fact hasn't changed since the law passed almost one year ago.

The more health care costs the fewer Americans can afford it. And it is just this calculus that has driven businesses, individuals, and even providers of care to call for fundamental change. It is very clear that it will take time to fix our current system; we won't turn around a $2.6 trillion industry that employs 15 million of us and touches 85 percent of Americans in one year. We have to manage a complex and complicated transition to a new system that will provide better care at an affordable price, and that will not be easy.

Change requires time and patience, and yet, there seems to be little of the latter in the current debate and even less among some seeking to overturn the law. The first of the key provisions in the Patient Protection and Affordable Care Act designed to lower costs are just going into effect. Many others changes are months or even years away. It is simply too soon to give up on the current approach. Folded into the law is cause for hope.

Modernizing the System

The reform law enabled a series of tools that, if implemented effectively, could finally begin to bend the cost trend and improve quality. For instance, the first of these tools already appeared at the dawn of 2011, the new Medicare Physician Compare website. If Medicare does right by consumers and continues to add meaningful data to the Physician Compare website, the site could eventually allow consumers to choose a doctor most effective for them, just like they are able to do with hospitals today.

Also starting in 2011, the Patient Centered Outcomes Research Institute (PCORI) will begin to compare the effectiveness of different treatments. Imagine being able to discern if that new, expensive technological procedure actually works better than treatments already in common use? If the Institute is adequately funded, it is the first step in moving toward a health care system that delivers care proven to work.

Starting in 2012, Medicare will launch Accountable Care Organization pilots, a new care delivery model that makes providers more responsible for working together to manage the cost and quality of the care they deliver. If these pilots are properly structured and expected to meet high standards, they could do a lot to control costs and improve care quality. Many hospitals and physician groups across the country are working hard to organize themselves into these new models, and are expecting to contract with private insurers and employers to offer the same care to all patients, not just those in Medicare. Catholic Healthcare West has already seen success in its pilot ACO serving Sacramento-area CalPERS members, reducing hospital readmissions by 22 percent and total hospital days by 13 percent.

And beginning in 2014, consumers will have a better option to find comprehensive coverage, choosing among insurance products they may actually be able to comprehend in the new health insurance marketplaces, called Exchanges. The exchanges represent a tremendous opportunity to not only expand coverage, but also to empower patients to choose a plan that is right for their needs. Most importantly, if they are structured correctly, the near universal coverage the exchanges will provide represents a chance to finally control rising health care costs, by eliminating much of the "cost shifting" that occurs from uncompensated care today.

All of us -- consumers, employers, and health care professionals -- need to channel our concerns and speak in a loud, unified voice to ensure these tools not only get implemented, but get implemented in ways that control costs and improve quality. To achieve their intended goals, these tools need support and funding. The passage of the health care reform law was not the final step in transforming our health care system; our real work begins now, as we all continue to work together to realize its promise.